~1H-MRS头针结合康复训练治疗脑梗死恢复期研究

目的:利用磁共振波谱技术(MRS)探讨不同方式头针干预脑梗死恢复期患者的疗效。方法:将40例脑梗死恢复期患者随机分为4组,每组各10例,A组采用于氏双侧头针结合康复训练,B组采用传统焦氏单患侧头针结合康复训练,C组采用于氏单患侧头针结合康复训练,D组采用单纯康复训练,各组均干预15 d。干预前后采用Fugl-Meyer评分量表(FMA)和MRS进行疗效评价。结果:治疗后FMA评分组间比较,A组均优于B组、C组(P0.05),A组优于D组(P0.01);各组N-乙酰天门冬氨酸(NAA)/肌酸(Cr)均较治疗前有所升高(P0.01);A组和B组胆碱(Cho)/Cr均较治疗前明显下降(P0.01,P0.05);NAA/Cr组间比较,A组优于其他3组(P0.01),B组、C组与D组比较,差异均有统计学意义(P0.05);Cho/Cr组间比较,A组优于B组和C组(P0.05),A组优于D组(P0.01)。结论:于氏双侧头针结合康复训练能够改善患者的运动功能,其运动功能的恢复与脑部相应代谢产物发生变化有关。     

头针配合促通技术治疗脑卒中偏瘫患者的临床疗效

目的:观察头针配合促通技术对恢复期缺血性脑卒中偏瘫患者肢体功能的影响。方法:恢复期缺血性脑卒中偏瘫患者45例,随机分为A、B、C 3组各15例。A组针刺健侧顶颞前斜线(运动区)治疗;B组采用Brunnstrom促通技术训练;C组两项结合治疗。治疗前后均进行神经功能缺损评分(NIHSS)评定临床疗效;简式Fugl-Meyer运动功能(FMA)和Barthel指数(BI)积分评定上下肢运动功能和ADL。结果:治疗21 d后,FMA及BI积分与治疗前比较3组均有明显提高(P0.01),其中FMA积分,B、C组上肢高于A组(P0.05);A、C组下肢高于B组(P0.05);BI积分,C组高于A、B组(P0.01)。3组临床疗效比较,C组基本痊愈率及总有效率均明显高于A、B组(40.0%与13.3%、13.3%;86.7%与73.3%、66.7%,P0.01)。结论:头针配合促通技术治疗能够有效提高恢复期缺血性脑卒中偏瘫患者的肢体运动功能和ADL,降低致残率。     

头针结合康复训练治疗急性脑梗死

目的:研究头针结合康复训练对急性脑梗死患者的疗效。方法:144例脑梗死患者随机分为4组各36例,4组均接受神经内科常规药物治疗,综合组同时接受头针治疗及康复训练,头针组同时接受头针治疗,康复组同时接受康复训练,对照组仅接受药物治疗。于治疗前和治疗8周后采用脑卒中残损评价表(SIAS)评价患者功能状况。结果:经过8周治疗,运动功能、肌张力、躯干平衡、关节活动范围及疼痛评分比较,综合组、头针组及康复组均明显高于对照组(P<0.05),其中综合组运动功能评分明显高于头针组和康复组(P<0.05),头针组与康复组比较差异无显著性意义(P>0.05)。结论:头针治疗结合康复训练可明显改善脑梗死患者的运动功能、肌张力、躯体平衡,增大关节活动范围,缓解疼痛,其疗效(尤其是运动功能的改善)明显优于单一采用头针治疗或康复训练的疗效。     

双侧头穴透刺对急性脑梗死患者血清中VEGF的影响

目的：探讨头穴透刺法治疗急性脑梗死的作用机理。方法：急性脑梗死患者69例,随机分为A、B、C 3组各23例,均给予常规药物治疗,A组与B组分别加用双侧与患侧百会穴透太阳穴针刺治疗。另选择健康体检正常者23例为对照（D组）。均采用双抗体夹心酶联免疫吸附法（ELISA）测定4组血清中血管内皮生长因子（VEGF）浓度的变化;并对A、B、C 3组治疗前后神经功能缺损程度评分。结果：治疗第10天时,A、B、C 3组患者血清中VEGF浓度与第1天及D组比较均明显上升（P〈0.05,0.01）,A组高于B、C组,B组高于C组（均P〈0.05）。治疗30 d时,A、B、C 3组神经功能缺损程度评分均较治疗前明显下降（P〈0.01）。A、B组明显低于C组,A组低于B组（P〈0.05）。结论：头穴透刺治疗能显著增加急性脑梗死患者血清中VEGF的浓度,保护脑组织,促进神经功能恢复,其双侧头穴透刺疗效更明显。     

银杏达莫静滴联合头针治疗急性脑梗死

目的观察银杏达莫静滴联合头针治疗急性脑梗死的疗效。方法选择183例急性脑梗死患者随机分为3组,每组各61例。3组均在常规控制血压、脱水等治疗的基础上,A组用血塞通注射液0.4 g、曲克芦丁注射液0.6 g每日1次静滴;B组用银杏达莫注射液20 ml每日一次静滴,同时每日头针治疗一次;C组用银杏达莫注射液20 ml每日1次静滴。3组均连续治疗14 d。观察3组治疗前后神经功能缺损改善情况。结果C组疗效优于A组(P<0.05),B组疗效优于A组(P<0.01)和C组(P<0.05)。结论银杏达莫静滴联合头针治疗急性脑梗死具有良好的疗效,简便安全。     

头穴丛刺结合康复训练治疗中度儿童自闭症的临床观察

目的:探寻治疗中度自闭症起效快、疗效显著的方法.方法:56例患儿分为针康组(20例),即于氏头穴丛刺同时进行康复训练;常规头针结合康复组(18例),即常规头针后再进行康复训练;康复组(18例),单纯康复训练.运用儿童自闭症评估量表对12周、24周后的疗效进行评价.结果:12周后针康组前后有显著差异(P＜0.05).24周后针康组在疗效等级上明显优于其他两组(P＜0.005).结论:针康法对中度儿童自闭症起效快、疗效显著,是一种更为有效的治疗方法.     

电针联合康复训练治疗帕金森病的临床研究

目的:观察电针联合康复训练治疗帕金森病(PD)患者的疗效.方法:PD患者87例,随机分为3组各29例,A组采用康复训练联合电针治疗;B组仅接受康复训练;C组仅接受电针治疗.结果:治疗60d后,3组患者韦氏综合评定量表中肌强直、姿势、步态、协同动作评分均较治疗前降低,且A组更低于B、C组(均P＜0.05);3组Bl评分均较治疗前明显提高,且A组更高于B组,B组更高于C组(均P＜0.05);3组UPDRSⅢ评分均较治疗前明显降低,且A组更低于B组,B组更低于C组(均P＜0.05);3组运动总有效率比较,A组＞B组＞C组(均P＜0.05).结论:电针联合康复训练能一定程度地改善PD患者的临床症状,提高患者的日常生活活动能力、生活质量及临床疗效,其疗效优于单独使用康复训练或者电针治疗.     

头针配合康复训练对脑瘫患儿运动功能的影响

目的:探讨头针配合康复训练治疗脑瘫(CP)患儿的疗效,为小儿CP的治疗探索新的有效方法。方法:将CP患儿106例随机分为2组,每组53例,对照组给予肢体康复训练,治疗组在肢体康复训练基础上进行头针治疗,2组均治疗12周,比较治疗前后粗大运动功能量表(GMFM-88)评分、下肢肌群肌张力评分、大脑中动脉收缩期血流速度和搏动指数、血清胰岛素样生长因子(IGF-1)、脑源性神经营养因子(BDNF)水平。结果:治疗后,2组粗大运动功能B、C、E区评分均较治疗前显著增加(P0.01),与对照组比较,治疗组各区评分均显著增加(P0.01);治疗后,2组内收肌、腘绳肌、腓肠肌肌张力均较治疗前明显降低(P0.01),治疗后治疗组与对照组比较,腘绳肌、腓肠肌张力显著降低(P0.01),内收肌张力差异无统计学意义;治疗后2组大脑中动脉血流速度升高(P0.05,0.01),搏动指数降低(P0.01),治疗组变化较对照组更为明显(P0.05,0.01);治疗后2组血清IGF-1、BDNF水平均较治疗前显著升高(P0.05,0.01),治疗组更高于对照组(P0.01)。结论:头针配合康复训练可增加脑组织血液灌注,促进损伤后脑组织修复,降低肌肉张力,改善CP患儿运动功能,治疗小儿CP效果显著。     

运动贴扎技术对急性踝关节外侧韧带损伤患者早期康复的影响

目的:探讨运动贴扎技术对急性踝外侧韧带损伤后患者踝关节早期康复的影响。方法:将符合入选标准的90例踝关节扭伤患者按随机数字表法分为实验组(A组)、安慰剂组(B组)、对照组(C组),每组30例。C组接受常规治疗(1次/d,30min/次,5d/周,共2周);A组、B组除常规治疗外(1次/d,30min/次,5d/周,共2周),同一天分别给予运动贴扎技术治疗、无拉力白贴(安慰剂)治疗(1次/d,5d/周,共2周)。三组患者均给予常规康复运动训练指导及健康教育,并在接受治疗前、治疗2周后进行患侧肢体平衡功能[X轴平均位移(Mcd)、Y轴平均位移(Msd)评分]、损伤韧带厚径及相关肌群表面肌电值[腓肠肌外侧头(GL)、腓肠肌内侧头(GM)、腓骨长肌(PL)评分]的评定。结果:治疗前,三组患者患侧肢体各项评分比较差异均无显著性意义(P0.05)。治疗2周后,组内前后比较,(1)表面肌电评估,即以相关肌群标准化肌电募集程度(均方根值RMS)为单位,测定步态项中肌群的肌电值:A、B两组表面肌电评分(GL、GM、PL)均较治疗前改善(P0.05),但C组三块肌肉评分较治疗前差异均无显著性意义;(2)平衡功能评估:A组、C组平衡功能Mcd、Msd评分较治疗前差异均有显著性意义,且A组较前改善(P0.005)、C组较前下降(P0.001),B组Mcd评分较治疗前改善(P0.001),但B组Msd评分较治疗前差异无显著性意义(P0.05);(3)韧带厚径评估:三组韧带厚径评分均较治疗前改善(P0.001)。治疗2周后,组间比较,A组韧带厚径评分、表面肌电评分(GL、GM、PL)均优于B组和C组(P0.01);A组平衡功能评分(Mcd、Msd)均优于C组(P0.005)、Msd评分优于B组(P0.05),但Mcd评分与B组比较差异无显著性意义(P0.05);B组仅平衡功能评分(Mcd、Msd)优于C组(P0.001),B、C两组其他评分比较差异均无显著性意义(P0.05)。结论:运动贴扎技术治疗可提高踝关节外侧韧带损伤患者平衡控制能力和相应肌群功能,加速损伤韧带的恢复。     

头针与体针治疗脑卒中亚急性期吞咽障碍的比较

目的比较头针与体针治疗脑卒中亚急性期吞咽障碍的差别,探讨其临床疗效和安全性。方法将脑卒中亚急性期(15～40d内)患者78例按序平均分为头针(A)组、体针(B)组及单纯康复训练(C)组(对照组)。头针组采用针刺头针运动区及感觉区的下1/5区域。体针组采用针刺风府、人迎、廉泉、百劳等穴位。3组均予中西药物同等治疗及吞咽障碍基本康复训练。各组治疗前后均以吞咽障碍饮水试验功能评级、吞咽障碍程度评分或电视荧光吞咽功能评价。结果A组治愈率35%(9/26),有效率58%(15/26),总有效率93%;B组治愈率31%(8/26),有效率62%(16/26),总有效率93%;C组治愈率4%(1/26),有效率54%,总有效率58%;A、B组疗效均明显优于C组(对照组)(P<0.01,χ2=9.7),误吸性肺部感染率A组23%和B组31%低于C组87%(χ2=7.88,P<0.01);针刺引起的心血管性反应A组少于B组(χ2=4.17,P<0.05)。结论头针与体针对脑卒中亚急性期吞咽障碍均有确切疗效,头针安全性优于体针。     

Living with a woman with fibromyalgia from the perspective of the husband

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome, which affects mostly middle-aged women. The syndrome is poorly understood and treatment is mainly palliative. The diagnosis is established from diagnostic criteria. Living with FM means living a life greatly influenced by the illness in various ways for people affected. Aim of the study. The aim of this study was to describe the experiences of living with a woman with FM from the husbands' perspective. METHODS: Five men married to women with FM were interviewed using a narrative approach. The interviews were analysed using qualitative thematic content analysis. FINDINGS: The analysis resulted in the following seven themes: increasing responsibility and work in the home; being an advocate for and supporting the wife; learning to see the woman's changing needs; changing relationship between spouses; changing relationship with friends and relatives; deepening relationship with the children and lacking information and knowledge about FM. The findings show that the women's illness had a great impact on husbands' lives, and that husbands lacked information about the woman's illness. CONCLUSION: This study shows that it is not only the women with FM who experience a changed life; the whole family life is influenced and limited by FM. The husband's role in the family changes, first and foremost concerning responsibility and workload within the family. This must be taken into consideration in care planning. This study also highlighted the need of information and knowledge about FM expressed by the participants, information that health care personnel have a great responsibility to give.     

Use of the Role Checklist with the patient with multiple personality disorder

A paucity of occupational therapy evaluation tools exists for use with patients with multiple personality disorder. The Model of Human Occupation (Kielhofner & Burke, 1980), particularly the volition and habituation subsystems within this model, proved useful for the identification of the many facets of patients with multiple personality disorder on a short-term treatment unit. The Role Checklist (Oakley, Kielhofner, Barris, & Richler, 1986), a tool derived from the Model of Human Occupation, was adapted for use with this population and was found to be beneficial in the identification of common goals held by most of the personalities of each patient with multiple personality disorder. The use of the Role Checklist is illustrated with a case example.